Abstract WMP10: The Role of Intravenous Thrombolysis Before Mechanical Thrombectomy: A Subgroup Analysis of the RESILIENT Trial

Background: Mechanical thrombectomy (MT) in addition to intravenous thrombolysis (IVT) is now the recommended treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The positive trials also demonstrated that MT alone among patients ineligible for IVT is an effective therapy for AIS. Whether MT alone is as effective, worse, or better than pretreatment with IVT before MT among IVT-eligible AIS patients with LVO is debatable. We aimed to assess the effect of IVT on the clinical outcome of MT in the RESILIENT trial. Methods: RESILIENT was a randomized, prospective, multicenter, controlled trial evaluating the safety, efficacy, and cost-effectiveness of thrombectomy versus medical treatment alone. A total of 221 patient were enrolled. The trial showed a strong benefit to thrombectomy (90-day mRS ordinal shift, OR 95%CI). All eligible patients received intravenous tPA within the 4.5-hour-window. The primary end-point was the common odds ratio (cOR) of mRs at 90 days (shift analysis) and the main secondary endpoint was the rate of functional independence (mRS 0-2) at 90 days. Ordinal logistic and binary regression analyses with the use of intravenous tPA as an interaction term were performed with adjustments for potential confounders including age, baseline NIHSS score, occlusion site, IV tPA use and ASPECTS. A p value < 0.05 was considered statistically significant. Results: Among 221 randomized patients (median NIHSS, 18 IQR [14-21]), 155 (70%) were treated with IV tPA. The frequency of good recanalization (TICI 2b> ) and of hemorrhagic transformation was not affected by IVT. There was no significant difference in the treatment effect size across patients who received intravenous tPA versus those who did not in terms of overall functional disability (ordinal mRS shift: aOR: 2.63, 95%CI [1.48-4.69] vs. 1.54, 95%CI [0.63-3.74]; p=0.42) or functional independence (mRS 0-2: aOR: 3.06, 95%CI [1.37-6.48] vs. 1.71 95%CI [0.55-5.33], p=0.40) at 90 days. Conclusions: The large effect size of MT on LVO outcomes was not significantly affected by IVT. Further studies directly evaluating the role of IVT before MT are of utmost importance.

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Abstract 5: CT Perfusion is Not a Treatment Effect Modifier for Mechanical Thrombectomy in the 0-8-Hour-Window: A Pre-Planned Analysis of the RESILIENT Trial

Stroke ◽

10.1161/str.51.suppl_1.5 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Leticia C Rebello ◽

Bruno S Parente ◽

Eduardo S Waihrich ◽

Octavio Pontes-Neto ◽

Daniel G Abud ◽

...

Keyword(s):

Treatment Effect ◽

Effect Size ◽

Functional Disability ◽

Ct Perfusion ◽

Controlled Trial ◽

Functional Independence ◽

Control Group ◽

P Value ◽

Treatment Effect Size ◽

Significant Difference

Background: CT perfusion has been increasingly used as a selection tool in acute reperfusion therapies. However, it remains unknown whether its use is associated with a higher treatment benefit in patients undergoing thrombectomy. We sought to evaluate the interaction between imaging selection modalities and treatment effect in the RESILIENT Trial. Methods: RESILIENT was a randomized, prospective, multicenter, controlled trial evaluating the safety, efficacy, and cost-effectiveness of thrombectomy versus medical treatment alone in Brazil. A total of 221 patient were enrolled. The trial showed a strong benefit of thrombectomy (90-day mRS ordinal shift, OR 2.28 95%CI [1.41-3.70]; p=0.001). Key imaging selection criteria included ASPECTS ≥6 on non-contrast CT (NCCT) and the exclusion of malignant collateral profile on CT angiography. The use of automated CT perfusion software (RAPID, IschemaView) was optional but was made available in some centers with the pre-specified plan to compare imaging selection modalities. The primary end-point was the common odds ratio (cOR) of mRs at 90 days (shift analysis) and the main secondary endpoint was the rate of functional independence (mRS 0-2) at 90 days. Ordinal logistic and binary regression analyses with imaging selection modality (NCCT versus CTP) as an interaction term were performed with adjustments for potential confounders including age, baseline NIHSS score, occlusion site, IV tPA use and ASPECTS. A p value < 0.05 was considered statistically significant. Results: CTP was performed in 41% of the thrombectomy group and 45% in the control group. There was no significant difference in the treatment effect size for patients selected on the basis of NCCT and CTA only versus those submitted to CTP in terms of overall functional disability (ordinal mRS shift: aOR: 2.87, 95%CI [1.47-5.61] vs. 2.10, 95%CI [1.01-4.36]; p=0.390) or functional independence (mRS 0-2: aOR: 3.16, 95%CI [1.32-7.57] vs. 2.54 95%CI [0.86-7.49], p=0.40) at 90 days. Conclusion: In a randomized clinical trial of thrombectomy within 8 hours of stroke onset, there was no evidence of difference in the treatment effect size across patients selected with NCCT and CTA alone versus automated CT perfusion software.

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Abstract WP25: Concomitant IV tPA Does Not Increase Harm to Patients Who Receive Simultaneous Mechanical Thrombectomy and Emergent Carotid Artery Stent Treatment

Stroke ◽

10.1161/str.44.suppl_1.awp25 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Hormozd Bozorgchami ◽

Jeremy Fields ◽

Gary Walker ◽

Cindy Jahans ◽

Helmi Lutsep ◽

...

Keyword(s):

Carotid Artery ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Treated Group ◽

Stroke Patients ◽

Time To Treatment ◽

Exact Test ◽

Symptomatic Intracerebral Hemorrhage ◽

Significant Difference ◽

Iv Tpa

Background: Stenting of the cervical internal carotid artery (ICA) may be performed acutely in patients undergoing endovascular intervention for stroke due to occlusion of the intracranial ICA or MCA. It is unclear if pre-intervention IV tPA increases complications of carotid artery stenting (CAS) in this group. Hypothesis: We assessed the hypothesis that pre-intervention IV tPA does not increase the risk of complications in acute ischemic stroke patients (AIS) who require concurrent mechanical thrombectomy and emergent CAS. Methods: Patients undergoing both mechanical thrombectomy and CAS within 24 hours of stroke onset were identified from the Merci Registry, a prospective database of AIS patients treated with the Merci Retriever. Those receiving IV tPA were compared with those that did not for associations with functional independence (mRS 0-2) and risk of symptomatic intracerebral hemorrhage (sICH). The primary endpoint for this study was the percentage of patients with mRS 0-2 at 90 days. Secondary endpoints included 90-day mortality and sICH. Outcomes were compared with Fisher’s exact test. Results: 103 patients were included. Thirty received IV tPA (mean age 59.1, time to treatment 6.3 hrs, median NIHSS 18) and 74 did not (mean age 66.1, time to treatment 9.8 hrs, median NIHSS 16). Although numerically higher, there was no significant difference in sICH at 24 hours, occurring in 18.2% (4/22) of IV tPA patients and 7.3% (4/55) of patients without IV tPA (p=0.22) [sICH data was not available on 28 patients]. At 90 days, 40% of the IV tPA group (12/30) was functionally independent while 30.6% (22/73) was functionally independent in the non-IV tPA group (p=0.36). There was no difference in 90-day mortality between the two groups (26.7% vs. 34.7%, p=0.67). Conclusions: This study demonstrates that concomitant IV tPA use in acute stroke patients who had simultaneous mechanical thrombectomy and CAS did not significantly affect patient outcomes or increase complications. Although neither result was statistically significant, there was a trend toward improved functional outcomes at 90 days in the IV tPA treated group despite a trend toward increased rates of sICH.

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Abstract WMP1: Cost Effectiveness Analysis of Mechanical Thrombectomy: the THRACE Randomized Trial

Stroke ◽

10.1161/str.48.suppl_1.wmp1 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hamza Achit ◽

Francis guillemin ◽

Marc Soudant ◽

Kossar Hosseini ◽

Aurelie Bannay ◽

...

Keyword(s):

Ischemic Stroke ◽

Randomized Trial ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Cost Effective ◽

Functional Independence ◽

Quality Adjusted Life Year ◽

Significant Difference ◽

Quality Adjusted Life

Background and purpose: The benefit of mechanical thrombectomy added to intravenous thrombolysis in patients with acute ischemic stroke has been largely demonstrated. However, evidence on economic incentive of this strategy is still limited, especially in the context of randomized trial. The purpose of this study is to analyze whether the combination of mechanical thrombectomy with intravenous thrombolysis is more cost-effective than implementing intravenous thrombolysis alone. Patients and methods: Individual-level cost and outcome data were collected in the THRACE randomized clinical trial, including patients with acute ischaemic stroke and proximal cerebral artery occlusion. Patients were assigned to either intravenous thrombolysis (IVT; n = 208) or intravenous thrombolysis plus intra-arterial thrombectomy (IVMT; n=204). The primary outcomes were both modified Rankin scale of functional independence at 90 days (score 0-2) and the EuroQol-5D score of quality of life. This study considered the perspective of the National Health Security System in France. Results: Bridging therapy increased by 10.9% the rate of functional independence compared to IVT (53% vs 42,1%) at an increased cost of 1909 є, with no significant difference in mortality (12% vs 13%) or symptomatic intracranial haemorrhage (2% vs 2%). Cost per one averted case of disability was consequently estimated at 17,480 є. The incremental cost per quality-adjusted life year gained was 13,423 є. Sensitivity analysis showed that combined approach had 84.1% probability of being cost-effective regarding cases of averted disability and 92.2% probability regarding quality-adjusted life year outcome. The national implementation of this new strategy would result in additional cost of 12.9 million є and avoid about 737 cases of death or disability. Conclusions: Based on randomized trial, this study demonstrates that intravenous thrombolysis plus mechanical intra-arterial thrombectomy for treating acute ischemic stroke is more cost-effective than intravenous thrombolysis alone.

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Abstract P561: Efficacy of Beveled Tip Aspiration Catheter in Mechanical Thrombectomy for Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p561 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jan Vargas Machaj ◽

Jonathan Blalock ◽

Anand Venkatraman ◽

Vania Anagnostakou ◽

Robert King ◽

...

Keyword(s):

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Control Device ◽

P Value ◽

Patient Demographics ◽

Improved Outcomes ◽

Significant Difference ◽

Catheter Tip ◽

Thrombectomy Device ◽

Iv Tpa

Introduction: The ADAPT technique uses large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench-top exploration of a beveled-tip catheter, and our experience in treating large vessel occlusions using next-generation aspiration catheters. Methods: Twenty experiments were conducted with either a Sofia Plus or a Zoom71 using a vascular phantom in which a clot model was introduced. Rate of ingestion, complete recanalization after a single attempt, and pressure at the catheter tip for both devices were recorded. A retrospective analysis from a prospectively-maintained database was performed. Patient demographics, periprocedural metrics, discharge and 90-day modified Rankin Scales were collected. Patients were divided into two groups based on which aspiration catheter was used. Results: In our bench-top experiment, complete ingestion of the clot occurred in 90% of beveled tip and 20% of control device experiments (p=0.006). Our clinical data demonstrated no significant difference in age, gender, IV tPA administration, admission NIHSS, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, TICI 2C or better recanalization was more frequent (93.2% vs 74.2%, p-value 0.017), stent retriever usage was lower (9.1% versus 29%, p-value 0.024), and patients had lower mRS on discharge (median 3 vs 4, p less than 0.001) and at 90 days (median 2 vs 4, p=0.008). Conclusion: The beveled tip design leads to more frequent clot ingestion in a bench top model, which may translate into a more efficacious thrombectomy device with improved outcomes.

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The Role of Prolotherapy in Fibromyalgia Patients

QJM ◽

10.1093/qjmed/hcaa064.008 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

N Elsheshtawy ◽

N Fouda ◽

M Nassif ◽

N Ahmed

Keyword(s):

Functional Disability ◽

Whole Body ◽

P Value ◽

Tender Points ◽

Daily Life Activities ◽

Significant Difference ◽

Scale Total Score ◽

Average Pain

Abstract Objectives To assess the potential role of prolotherapy in treating the most tender points of FM patients as a trial to improve symptoms. Patients and Methods 20 primary FM Patients were injected with 3 cc of 25 % dextrose with 2 cc of 1 % lidocaine and then filled to 6 cc total volume with saline, making dextrose concentration of 12.5%, with 0.5 ml of the solution prepared per point,with a maximum of 6 points/ session. - Follow up visit were required every two weeks for other injections over a course of six weeks (duration of healing cascade). After 6 weeks, patients were assessed using NRS, FIQ VAS , MFI - 20 , SQS and PHQ-9 scales. Results As regard number of tender points, there was a highly Statistically significant P- value (<0.001) between number of tenderpoints (6-16) before injection, which decreased to (5-9) after injection, with a change of 34.17%. As regard whole body average pain, there was a highly Statistically significant difference (<0.001) between NRS before injection(5-10), which decreased to a range of (2-6) after injection, with a change of 39.57%. PHQ-9 scale total score showed a highly Statistically significant difference (P – value<0.001), ranging from (15-22) pre injectionand dropped to (10-18) post injection, with an improvement of 25.37%. Conclusion Prolotherapy may offer great therapeutic advantages for FM patients, as it is well tolerated with minimal or no side effects. Moreover, prolotherapy injection reduces pain intensity and functional disability in daily life activities.

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Comparative Study on Vit. E & Mefenamic acid vs Mefenamic acid alone on mean reduction in pain in Primary Dysmenorrhea

10.53350/pjmhs2115123195 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3195-3197

Author(s):

Fariha Sadiqa ◽

Mufakhara Fatimah ◽

Abdul Mudabbir Rehan ◽

Sidra Mushtaq ◽

Asia Firdous ◽

...

Keyword(s):

Vitamin E ◽

Mefenamic Acid ◽

Controlled Trial ◽

Acid Group ◽

P Value ◽

Primary Dysmenorrhea ◽

High Concentration ◽

Randomized Controlled ◽

Significant Difference ◽

Menstrual Fluid

Background: Pelvic pain around the time of mensturation without any identifiable pathologic lesion present from menarche is called primary dysmenorrhea. The pain is believed to be related to prostaglandin (PG). Women with dysmenorrhoea have a relatively high concentration of PGF 2 alpha in menstrual fluid and suppression of PG synthesis has become the main treatment. Aim: To compare mean reduction in pain in patients presenting with primary dysmenorrhea given vitamin E & Mefenamic acid versus Mefenamic acid alone. Results: It was a randomized controlled trial which was conducted in Department of Obstetrics & Gynecology, THQ Raiwind Hospital, Lahore for 6 months duration w.e.f 01/02/2017 to 31/07/2017. In this study, 18(36%) in Vitamin-E group and 21(42%) in Mefenamic acid group were between 15-20 years while 32(64%) in Vitamin-E group and 29(58%) in Mefenamic acid group were between 21-25 years, mean±sd was calculated as 20.86±2.92 and 20.66±2.86 years respectively, mean dysmenorrheal pain at baseline was recorded as 50.06±10.27 in Vitamin-E group and 50.14±10.28 in Mefenamic acid group, p value < 0.754, showing that both groups are insignificant, mean dysmenorrheal pain after treatment was recorded as 20.50±10.04 in Vitamin-E group and 30.22±10.28 in Mefenamic acid group, p value was < 0.002 showing significant difference between the two group, comparison of mean reduction in dysmenorrheal pain after treatment was recorded as 20.56±0.91 in Vitamin-E group and 10.92±0.75 in Mefenamic acid group, p value was < 0.000, showing significant difference. Conclusion: We concluded that there is a significant mean reduction in dysmenorrhic pain in patients given Mefenamic Acid + Vitamen E as compared to patients given Mefenamic Acid alone. Keywords: Dysmenorrhic pain, Mefenamic Acid + Vitamen E, mean reduction in dysmenorrhic pain

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Abstract 1122‐000084: Does Intravenous Thrombolysis Promote Delayed Reperfusion After Incomplete Mechanical Thrombectomy?

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000084 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Adnan Mujanovic ◽

Christoph Kammer ◽

Christoph C Kurmann ◽

Lorenz Grunder ◽

Morin Beyeler ◽

...

Keyword(s):

Perfusion Imaging ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Considerable Proportion ◽

Time Interval ◽

Start Time ◽

Vessel Occlusion ◽

Stroke Registry

Introduction : The value of intravenous thrombolysis (IVT) in patients eligible for mechanical thrombectomy (MT) remains unclear. We hypothesized that pre‐treatment with and/or ongoing IVT may facilitate reperfusion of distal vessel occlusion after incomplete MT. We evaluated this potential association using follow‐up perfusion imaging. Methods : Retrospective observational analysis of our institution`s stroke registry included patients with incomplete reperfusion after MT, admitted between February 1, 2015 and December 8, 2020. Delayed reperfusion (DR) was defined as the absence of a persistent perfusion deficit on contrast‐enhanced perfusion imaging ⁓24h±12h after the intervention. The association between baseline parameters and the occurrence of DR was evaluated using a logistic regression analyses. To account for possible time‐dependent associations of IVT with DR, additional stratification sets were made based on different time windows between IVT start time and final angiography runs. Results : Among the 378 included patients (median age 73.5, 50.8% female), DR occurred in 226 (59.8%). Atrial fibrillation (aOR 2.53 [95% CI 1.34 ‐ 4.90]), eTICI score (aOR 3.79 [95% CI 2.71 ‐ 5.48] per TICI grade increase), and intervention‐to‐follow‐up time (aOR 1.08 [95% CI 1.04 ‐ 1.13] per hour delay) were associated with DR. Dichotomized IVT strata showed no association with DR (aOR 0.75 [95% CI 0.42 ‐ 1.33]), whereas shorter intervals between IVT start and end of the procedure showed a borderline significant association with DR (OR 2.24 [95% CI 0.98 ‐ 5.43, and OR 2.07 [95% 1.06 – 4.31], for 80 and 100 minutes respectively). Patients with DR had higher rates of functional independence (modified Rankin scale 0–2 at 90 days, DR: 63.3% vs PPD: 38.8%; p<0.01) and longer survival time (at 3 years, DR: 69.2% vs PPD: 45.8%; p = 0.001). Conclusions : There is weak evidence that IVT may favor DR after incomplete MT if the time interval between IVT administration and end of the procedure is short. In general, perfusion follow‐up imaging may constitute a suitable surrogate parameter for evaluating medical rescue strategies after incomplete MT, because a considerable proportion of patients do not experience DR, and there seems to be a close correlation with clinical outcomes.

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Effectiveness of sustained natural apophyseal glides in females with cervicogenic headache: A randomized controlled trial

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210018 ◽

2021 ◽

pp. 1-7

Author(s):

Muhammad Kashif ◽

Nosheen Manzoor ◽

Rimsha Safdar ◽

Hafsa Khan ◽

Maryam Farooq ◽

...

Keyword(s):

Treatment Group ◽

Controlled Trial ◽

Neck Disability Index ◽

Placebo Treatment ◽

Cervicogenic Headache ◽

Control Group ◽

P Value ◽

Head Positioning ◽

Significant Difference ◽

Neck Disability

BACKGROUND: Cervicogenic headache (CGH) is a common condition that results in significant disability. To treat this dysfunction, Mulligan described sustained natural apophyseal gliders (SNAGs) as a manual therapy approach. However, only inconclusive short-term evidence exists for treating CGH with SNAGs. OBJECTIVE: The present study aims to investigate the effect of SNAGs in the treatment of CGH. METHODS: Fourty female patients ranging from 20 to 40 years with CGH were randomly assigned to two groups: 20 in a treatment group and 20 in a control group. SNAGs were applied to the treatment group while the control group received placebo treatment. Both groups received their respective treatment for 20 minutes, alternately three times per week, for a total of 12 times in four weeks. The outcome measures were the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). Participants were assessed at baseline and at the end of each week. The data was analyzed using SPSS version 20. Independent t-testing was used to reveal changes between groups. One-way ANOVA was used to determine changes within groups. The level of significance was P< 0.05. RESULTS: Twenty participants (100%) in the treatment group and 17 (85%) in the control group had a history of headache aggravation with active movements or passive head positioning. There was no significant difference at baseline (p> 0.05), indicating that both groups were homogeneous at the time of recruitment. The p value (p< 0.05) showed a significant difference in pain and level of disability at three and four weeks (p< 0.05) in patients treated with SNAGs. However, the cervical range of motion (ROM) showed a statistically significant improvement in flexion and extension in the treatment group (p< 0.05) while there was no significant improvement in side flexion and rotation ROM in both groups (p> 0.05). CONCLUSION: This study found that SNAGs were effective in reducing pain and neck disability and improved ROM in females with CGH.

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Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013532 ◽

2017 ◽

Vol 10 (9) ◽

pp. 828-833 ◽

Cited By ~ 16

Author(s):

Abhi Pandhi ◽

Georgios Tsivgoulis ◽

Rashi Krishnan ◽

Muhammad F Ishfaq ◽

Savdeep Singh ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Large Vessel ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Logistic Regression Models ◽

Scale Scores ◽

Stroke Center ◽

Few Data

BackgroundFew data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO.MethodsConsecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0–2).ResultsThe study population included 217 patients with ELVO (mean age 62±14 years, 50% men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33%). Patients with APT pretreatment had higher SR rates (77% vs 61%; P=0.013). The two groups did not differ in terms of sICH (6% vs 7%), 3-month mortality (25% vs 26%), and 3-month functional independence (50% vs 48%). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95% CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95% CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95% CI 0.63 to 5.03; P=0.276).ConclusionAPT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.

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First attempt recanalization with ADAPT: rate, predictors, and outcome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014294 ◽

2018 ◽

Vol 11 (7) ◽

pp. 641-645 ◽

Cited By ~ 11

Author(s):

Mohammad Anadani ◽

Ali Alawieh ◽

Jan Vargas ◽

Arindam Rano Chatterjee ◽

Aquilla Turk ◽

...

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Hemorrhagic Transformation ◽

Lower Mortality ◽

Anterior Circulation ◽

Tandem Occlusion ◽

First Pass ◽

Baseline Characteristics ◽

Iv Tpa

IntroductionThe rate of first-attempt recanalization (FAR) with the newer-generation thrombectomy devices, and more specifically with aspiration devices, is not well known. Moreover, the effect of FAR on outcomes after mechanical thrombectomy is not properly understood.ObjectiveTo report the rate of FAR using a direct aspiration first pass technique (ADAPT), investigate the association between FAR and outcomes, and identify the predictors of FAR.MethodsThe ADAPT database was used to identify a subgroup of patients in whom FAR was achieved. Baseline characteristics, procedural, and postprocedural variables were collected. Outcome measures included 90-day modified Rankin scale (mRS) score, mortality, and hemorrhagic complications. Multivariate logistic regression was used to identify FAR predictors.ResultsA total of 524 patients was included of whom 178 (34.0%) achieved FAR. More patients in the FAR group than in the non-FAR group received IV tPA (46.6% vs 37.6%; p<0.05). For the functional outcome, higher proportions of patients in the FAR group achieved functional independence (mRS score 0–2; 53% vs 37%; p<0.05). Additionally, we observed lower mortality and hemorrhagic transformation rates in the FAR group than the non-FAR group. Independent predictors of FAR in the anterior circulation were pretreatment IV tPA, non-tandem occlusion, and use of larger reperfusion catheters (Penumbra, ACE 64–68). Independent predictors of FAR in the posterior circulation were diabetes, onset-to-groin time, and cardioembolic etiology.ConclusionFAR was associated with better functional outcome and lower mortality rate. When ADAPT is used, a larger aspiration catheter and pretreatment IV tPA should be employed when indicated.

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